PSW 1024 Week 4: Chapter 12 Abuse Awareness

• PSW 1024, Week 4, Chapter 12: Abuse Awareness

Objectives

• Identify and describe the 5 types of abuse
• Describe role of PSW as it relates to observing or suspecting abuse
• Describe spousal abuse
• Describe child abuse and what puts them at risk
• Describe elder abuse and risk factors
• Describe prevention of abuse of clients by health care workers
• Explain workplace violence
• Explain the cycle of abuse

Abuse

• Abuse is physical or mental harm caused by someone in a position of trust.
• The abuser is typically a family member, partner, or caregiver.
• Abuse implies a relationship existing between the abuser and the abused.
• Abusers have control over their victims.
• Victims are physically, emotionally, or financially dependent on their abusers.
• Abuse occurs at all social levels and in all cultures.

Canadian Charter of Rights and Freedom

• Canada values equality and diversity, ensuring no one should be abused or treated unfairly.
• Canadians are legally obligated to respect the rights of others, in accordance with Box 12-1: The Rights and Freedoms of All Canadians (p. 176).

Types of Abuse

• Physical:
  • Involves force or violence causing pain, injury, and sometimes death.
• Sexual:
  • Includes unwanted sexual activity, sexual harassment, conduct, comment, gesture, threat, or suggestion of a sexual nature)
• Emotional/Psychological:
  • Involves words or actions that inflict mental harm.
• Financial:
  • Concerns misuse of money or property.
• Neglect:
  • Refers to failing to meet basic needs.
• Bullying and cyberbullying (Box 12.2)

Cycle of Abuse

• Abuse typically follows a pattern:
  • Tension-building phase
  • Abusive phase
  • Honeymoon phase
• Over time, the episodes happen more frequently and intensely.
• See figure 12-1, page 182 for details.

Signs of Abuse

• Support workers are responsible for recognizing the signs abuse, however are not qualified to judge whether or not a client is being abused.
• Report any suspicions or observations of abuse to your supervisor immediately.
  • Refer to "Think About Safety Box: Signs and Symptoms of Abuse" (p. 180)
  • Call 911 if abuse is actively happening but ensure safety first.

Abusive Relationships

• Abuse can occur in various relationships.
• Abuse occurs in all types of families (rich and poor, educated and uneducated)
• Abusive relationships are complex with no single cause.
• Likelihood of abusive behavior increases if:
  • Alcohol and/or drugs involved
  • Mental illness, severe personality flaws such as explosive tempers are present
  • Past experience of abuse as a child
  • High stress periods (divorce, unemployment, poverty, illness)

Spousal Abuse

• A type of abuse between intimate partners in marriage or common-law relationships.
• Power and control are exerted by one partner over the other through abuse.
• Abuse can be physical, sexual, emotional, financial, or social.
• Multiple forms of abuse are usually present concurrently.
• Individuals of all genders may be abused, although women are more severely injured, on average.
• Male abuse in man-woman relationships is less reported.
• Domestic violence cases often spike during pregnancy or when caring for an infant.
• Victims may choose to stay with an abusive partner due to fear, financial reasons, guilt, concern for children, feeling responsible, not feeling believed, or hoping the partner will change.

Child Abuse

• Mistreatment or neglect of a child by a parent, guardian, or caregiver.
• Child abuse occurs at every social level and is a gross misuse of authority.
• Adjustments for child abuse can have lasting effects.
• Abused children are at greater risk of becoming abusive and committing crimes in the future.

Types of Child Abuse

• Physical Abuse:
  • Deliberate application of force causing injury.
  • Involves shaking, choking, biting, kicking, burning, or restraining.
  • Sometimes confused with physical punishment
• Emotional Abuse:
• Not meeting a child’s needs for affection, humiliating, rejecting, or calling names.
• Intimidation, exploitation, terrorizing, or routinely making unreasonable demands.
• Child Sexual Abuse:
  • Rape, molestation, incest, pornography, or prostitution inflicted on a child.
• Child Neglect:
  • Physical Neglect: Depriving a child of food, clothing, or medical care
  • Emotional Neglect: When a child’s needs to be loved, and needed for safety are unmet.
• Legal Requirement:
  • Report child abuse or the suspicion of said abuse.

Situations That Increase Risk of Child Abuse

• Family Crisis:
  • divorce, unemployment, poverty
• Single-Parenting:
  • Includes Stress and Financial Problems
• Isolation:
  • No Close Family Member or other Relationships
• Caring for Children with Special Needs
• Failure to Thrive:
  • Below the Norms for Body Weight, Growth, and Development

Measures to Prevent Child Abuse

• Parenting Education Programs
• Child Abuse Prevention Programs
• Supportive actions and behaviours
• Childhood education to help recognize and reject abusive or exploitive behaviour.

Elder Abuse

• Older adults are at risk for all types of abuse.
  • Commonly financial and emotional abuse.
• Abusers are typically family members.
  • Older Adult’s primary caregivers
• Older adults often do not report due to fear of the abuser or being moved to a new facility.
• Family caregivers may be abusive when they resent their role

Factors Increasing Older Person's Risk for Abuse

• High Stress Levels for Caregivers:
  • Often resulting in caregiver exhaustion
• Ageism:
  • Biased discrimination, disrespecting the dignity/abilities of older adults.
• Vulnerability Factors:
  • Poor Living Conditions, Unemployment, Dislocation in New Area, Racism/Homophobia, Social Isolation/Language Barriers, Disabilities, Economic Vulnerabilities, and Lack of Access to Community/Health Services.

Abuse of Clients by Health Care Workers

• Occurs in facilities or home care settings by any member of the health care team.
• Clients can be at risk for all types of abuse (physical, sexual, emotional, financial).
• Inappropriate restraint use, rough handling, client isolation, theft, lack of care plan reviews, no responsiveness to calls for help, infrequent client checks, and unmet basic needs are all types of abuse.
• Providing care against a client's wishes is a violation of rights and a form of abuse.
• Abuse often happens when worker is under stress and lacks proper training to cope with the situations at hand.
• Must recognize signs of stress and ask for help
• Request another assignment or discuss concerns with a supervisor if client causes stress.

What To Do if Clients Speak of Abuse

• Listen attentively
• Reassure the clients that you believe what they have said
• Stay calm and do not show anger or disgust
• Do not deny or ignore the problem
• Assure your clients that you will do what you can to help
• Notify your supervisor immediately
• Provide clients emotional support, no matter what they decide to do
• Remember that you cannot force adults to make a certain decision or take a particular action
• People who are capable of making their own informed decisions have the right to decide for themselves whether to live with the abuse or to accept help
• This choice is their right, and you must accept their decision
• People who are not capable of making informed decisions must get professional help

How to Report Abuse

• Record all observations and notes
• Accurately record the victim's and alleged abuser's details (name, address, age, gender, specific time/dates)
• Provide a detailed description of the neglect
• Protect privacy by only informing those who need to know.

Legal Responsibilities of PSWs

• Canadian Legislation:
  • Every Canadian province and territory have legislation that provides a duty bound mandate to report.
  • This is in response to suspecting a child, a person with physical or mental challenges, or an older adult being abused by a caregiver, guardian, etc.
• Mandatory Reporting:
  • Child abuse or even the suspicion of it must be reported immediately to child-protection authorities.
  • Abuse of Older Adults and Adults with Disabilities must also be reported.
• Consequences:
  • Failure to report child abuse can result in fines or imprisonment in some provinces.
• Protection for Reporting Individuals:
  • Those reporting are protected from any kind of legal action, as long as the report is not falsely motivated through malice.

Reporting Abuse Contacts

• Kids' Help Phone: 1-800-668-6868
• Abuse may be reported to:
  • A Child welfare agency
  • A Social service agency
  • Police department
  • Hospital, mental health centre, distress centre
  • Community service organisation
  • Phone 211 for community support/resources

Abuse of Health Care Workers

• Health care workers sometimes experience abuse.
• Caregivers are at risk from:
  • Another member of the team
  • Clients with mental illness or cognitive impairment
  • The employer themselves
• Never ignore or accept abusive behaviours.
• When abuse occurs, Discuss with supervisor
• May be necessary to reach out to police
• Abusive behaviors can include:
  • Swearing, name calling, hitting, pushing, kicking, spitting, biting, pinching
  • Inappropriate touching, phone calls or home visits

Inappropriate Sexual Behaviour of Clients

• Health care team members may have to help meet a sexually forward patient's needs.
• Behaviour may be unintentional due to cognitive impairment.
• Includes flirting, exposing themselves, or inappropriate touching.
• Be professional by informing patient you will not satisfy those needs.
• Inform patient that those needs are not appropriate and uncomfortable to meet.
• Discuss the situation with nurse in charge
• Review "Think About Safety Box: What to do when a client is abusive (p. 188)"

Sexual Harassment

• A form of sexual abuse that can happen in the workplace.
• Can include sexual comments, gestures, or suggestive threats.
• It is inappropriate if it makes you uncomfortable.
• Harassment could be initiated by a client, family or co-worker
• Tell person firmly and politely that this is unacceptable and unwelcome
• Be assertive but never rude.
• Discuss with supervisor and keep private documentation.
• All employers are required to prevent sexual harassment with workplace policies.

Workplace Bullying

• Duty on employers to protect employees from workplace harrassment
• Workplaces can sometimes demonstrate disrespectful and rude behaviours
• Could include harm from both mental and physical harrassment
• Actions to take if you are being bullied include;
  • Tell the person to stop
  • Take personal notes
  • Keep letters or emails from the person
  • Do not retaliate against them